Surgery clerkship shelf performance: evaluating the impact of required didactic hours on exam scores

Purpose During the COVID-19 pandemic, virtual and alternative teaching strategies were developed with subsequent changes in the number of required didactic hours. However, the exact relationship between number of didactic hours and performance on the National Board of Medical Examiners (NBME) Subject Exams is not clear. This study aims to evaluate the impact of reduced didactic hours on medical student NBME performance during the third-year surgery clerkship. Methods This retrospective study evaluated the first-time pass rates and mean scores on the NBME exam for medical students who participated in an eight-week surgery clerkship at a single institution between 2017 and 2022. Didactic schedules, including hours of synchronous and asynchronous content, and de-identified scores were obtained. Analysis of Variance (ANOVA) test, chi-squared test, linear regression, and logistic regression were used to assess for differences in scores and pass rates as a function of didactic hours. Results The cohort included 964 students. The mean NBME score was 72.23 and differed significantly across didactic hours ( p < 0.001). Compared to students who received 15 didactic hours, those who received 25.5, 33, and 37 h had 2.93 ( p = 0.01), 3.44 ( p = 0.004), and 2.41 ( p = 0.049) times odds of failing, respectively. Conclusions Increased didactic hours during surgery clerkships was not associated with higher NBME scores or first-time pass rates. Reducing didactic hours may improve exam performance and allow students more independent study time while decreasing faculty burden. Future research should seek to understand how reduced hours impacts students’ subjective experience and well-being.